RITE Images 2005

Question 1

Answer 1

Adamantinous craniopharyngioma; “wet” keratin

Question 2

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Healed toxoplasmosis – multiple calcified lesions in brain B cerebral hemispheres & cerebellum @ G/W junction; AIDS pt

Question 3

Answer 3

X-linked adrenoleukodystrophy

Question 4

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Lesion involving the vascular territory of the anterior (superior) branches of the MCA

Cytotoxic edema -> vasogenic edema

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Ulegyria / cortical necrosis w/ gliosis @ depth of the sulci

Seen in perinatal hypoxic ischemic encephalopathy –

Pt w/ clumsy hands that worsened w/ age

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MLD metachromatic leukodystrophy – white matter demyelination that spares subcortical U-fibers

Question 7

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Tabes dorsalis

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Lafora body – myoclonic epilepsy

Question 9

Answer 9

Graves ophthalmopathy – MRI shows enlarged EOM

Question 10

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Colloid cyst of 3rd ventricle

Question 11

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Subependymal giant cell astrocytoma – can be seen in Tuberous Sclerosis

Question 12

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SDH -> no need for further testing à craniotomy

Question 13

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Cyclopia – alobar holoprosencephaly

Cyclopia occurs w/ midline cleavage defects & clefting of the lip or the palate is usually also present

Question 14

Answer 14

Hypertensive hemorrhage

Question 15

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Benign rolandic epilepsy

Question 16

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Germinoma – most common pineal region tumor

Question 17

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Colloid cyst

Question 18

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Mammilary bodies congested & discolored -> thiamine deficiency

Wernicke’s encephalopathy

Question 19

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Loculated encapsulated epidural abscess

Sagittal T1 show loculated fluic collection in posterior epidural space extending several levels in mid thoracic spine; SAS compressed à epidural space

Question 20

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Locus ceruleus -> NE

Question 21

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NCS - Temporal dispersion, Conduction block & slow conduction -> CIDP

Question 22

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Epidural hematoma

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Heterotopic gray matter

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MS

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**ALS** - corticospinal tracts &

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Initial positivity is the **onset latency** for terminal conduction velocity measures

Question 27

Answer 27

DNET – dysembryoplastic neuroepithelial tumor -\> do surgery

Question 28

Answer 28

B necrosis of GP -\> **Carbon Monoxide Intoxication**

Question 29

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Hemorrhage in brain stem, temporal lobes & cerebellar vermis

Question 30

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**Intracranial hypotension** 2ndary to persistent cerbrospinal fluid leak - **meningeal enhancement**

Question 31

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**Germinal matrix Hemorrhage** – complication of premature birth I – localized to germinal matrix only II – ruptured into ventricle III – “ + ventircular dilatation IV – “ ruptured into ventricular system & cerebral parenchyma

Question 32

Answer 32

**GBM** – CLOSED RING of enhancement

Question 33

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**Negri bodies** – intracytoplasmic inclusions Seen in Rabies

Question 34

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Child w/ CHF -\> venous **great vein of galen aneurysm**

Question 35

Answer 35

Herniated disc

Question 36

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Tumors that can affect pituitary- **glioma**

Question 37

Answer 37

Porencephalic cyst

Question 38

Answer 38

Complicated atherosclerosis b/c of plaque ulcerations

Question 39

Answer 39

**Neuritic plaques** – histologic criteria for making dx of AD

Question 40

Answer 40

**Meningioma** – intradural extramedullary mass *Ependymoma, astrocytoma & hemangioblastoma are INTRAmedullary lesions*

Question 41

Answer 41

**Toxoplasmosis** – lots of **edema out of proportion to lesion size** w/ contrast -\> see **ring enhancement**

Question 42

What clinical finding would you expect?

Answer 42

**Lesion in CN4** -\> superior oblique weakness -\> **diplopia**

Question 43

Answer 43

**Dandy Walker Malformation** – Enlarged posterior fossa Missing vermis, 4th ventricle connecting w/ cisterna magna

Question 44

Answer 44

**Anterior chiasm lesion** - Optic nerve lesion extending posteriorly to involve the anterior chiasm - temporal field defect in contralateral eye

Question 45

Answer 45

**Clivus chordoma** – mixed signal destructive mass invovling the clivus & nasopharynx 3rd & 4th decades Males \> Females Extradural \>1/2 arise in or adjacent to body of sphenoid bone

Question 46

Answer 46

**Anoxic injury of GP** (see repeat image on R w/ bright GP) Cerebral atrophy & enlarged CSF spaces **"CHAMWA"– carbon monoxide poisoning, hypoglycemia, AIDS, Meningitis, Wilson’s**

Question 47

Answer 47

**Thrombosis of superior sagittal sinus & deep cerebral veins** B nearly symmetric, parasagittal, cortical & BG venous infarctions

Question 48

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Balo’s concentric sclerosis – OPEN ring -\> demyelinating d/o demyelinated tissues form concentric layers

Question 49

Answer 49

Mural nodule - **cystic astrocytoma** \*\*If in cord or posterior fossa -\> hemangioblastoma

Question 50

Answer 50

**Oligodendroglioma** 30’s – 40’s – seizures If smoker w/ lung mass -\> metastatic lung CA Male w/ posterior fossa -\> medulloblastoma

Question 51

Answer 51

TEAM CHAOS ## Footnote **Pituitary adenoma**

Question 52

Answer 52

**Leigh’s disease** – bright symmetric BG & brain stem

Question 53

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String of beads – **Fibromuscular Dysplasia** (FMD) 1/3 assoc w/ aneurysms

Question 54

Answer 54

**_Hamartoma_ in tuber cinereum** Pt w/ precocious puberty

Question 55

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**Neurofibrillary tangles** – intraneuronal intracytoplasmic inclusion composed of paired helical filaments Can be seen in Pick, PSP, Down’s, Parkinson dementia complex of Guam, post-encephalitic Parkinsonism

Question 56

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**Subacute AIDS** – diffuse high signal intensity throughout all of the white matter

Question 57

Answer 57

Perivascular pseudorosettes - ependymoma

Question 58

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**Thrombosed superior sagittal sinus** – flow void Signal intensity of the thrombus over time has the same evolution pattern as intracerebral hematomas

Question 59

Answer 59

**Aspergillosis** - -\> can lead to hemorrhagic infarctions

Question 60

Answer 60

**Axonal spheroids – “shear injury”** – pts are rendered immediately unconscious w/ trauma -\>chronic “closed head injury”

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Answer 61

Chari I malformation

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No MCA trunk

Question 63

Answer 63

polymicrogyria

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**Toxoplasmosis** – tachyzoites & cysts containing bradyzoites

Question 65

Answer 65

Agenesis of corpus callosum

Question 66

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**Severe multicystic encephalomalacia due to intrauterine hypoxia/ischemia** – formation of cysts reflects cavitation which is the end stage of maturation of infarcts

Question 67

Answer 67

**HSV** – encephalomalacia in B temporal lobes L has cystic change & tissue loss

Question 68

Answer 68

wedge shaped area of dorsolateral portion of medulla -\> **PICA infarct; occlusion of vertebral artery**

Question 69

Answer 69

MS

Question 70

Answer 70

**Wilson’s disease** – putamen & thalami

Question 71

Answer 71

**Sleep spindles** – thought to be generated by the **reticular thalamic nucleus**

Question 72

Answer 72

Centronuclear myopathy

Question 73

Answer 73

**Pompe’s disease** – **acid maltase deficiency** **Severe vacuolar myopathy** due to extensive glycogen storage

Question 74

Answer 74

B medial temporal cortical dysplasia

Question 75

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**Schizencephaly w/ septo optic dysplasia** *Not porencephalic cyst b/c this would be lined by white matter NOT gray matter as shown here*

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**B frontal contusions** w/ slight orange tinge 2ndary to presence of residual hemosiderin-laden macrophages Olfactory nerves jacked -\> anosmia

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Answer 77

aneurysm

Question 78

Answer 78

Anterior cavum septum pellucidum

Question 79

Answer 79

Periventricular areas of demyelination -\> **MS**

Question 80

Answer 80

Flaky keratin -\> epidermoid cysts

Question 81

Answer 81

**GBM** – closed ring w/ enhancement

Question 82

Answer 82

Abnormal hyperintensity filling the vein of Galen & straight sinus (instead of normal flow void expected) -\> **thrombus in vein of Galen & straight sinus** -\> **hemorrhagic venous infarction in thalami**

Question 83

Answer 83

**Canavan’s disease** * MLD – spares U-fibers* * Adrenoleukodystroph – occipital & parietal regions*

Question 84

Answer 84

Ragged Red Fibers ## Footnote **Kearns-Sayre myopathy**

Question 85

Which CN would be affected?

Answer 85

CN 7 would be affected b/c of erosion to stylomastoid foramen

Question 86

Answer 86

**Gliomatous infiltration of leptomeninges**; leptomeningeal carcinomatosis?

Question 87

Answer 87

**Cystic hemangioblastoma** Cystic cerebellar hemispheric mass w/ enhancing mural nodule

Question 88

Answer 88

**Myokymic discharges** Can be associated w/ **potassium channel antibodies**

Question 89

Answer 89

Methemoglobin – containing subacute clot in subdural space

Question 90

Answer 90

C4-C5 most narrow portion of the cervical canal in this image

Question 91

Question 92

Answer 92

Cavernous angioma

Question 93

Answer 93

CJD – spongiform changes Mild to no atrophy of hippocampus

Question 94

Answer 94

* *Friedreich’s ataxia** – * *posterior columns & spinocerebellar tracts** Cardiomyopathy + adult onset of DM Dentatorubral – palliduloysian atrophy – thickening of skull Gynecomastia & testicular atrophy – spinal & bulbar muscular atrophy

Question 95

Answer 95

**“tufted astrocytes”** -\> seen in PSP (also see globoid neurofibrillary tangle)

Question 96

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**Globoid neurofibrillary tangle** – seen in SN, brainstem tegmentum, putamen, & select cortical areas -\> seen in PSP (also see tufted astrocytes)

Question 97

Answer 97

**Kernicterus** – infants who die w/ severe neonatal jaundice; see unconjugated bilirubin

Question 98

Answer 98

Wilson’s disease Kayser – Fleischer rings Alzheimer type II metabolic astrocytes

Question 99

Answer 99

CADASIL – Associated migraine HA Anterior temporal damage Family history - NOTCH 3 Gene, Chr 19

Question 100

Answer 100

TPA & heparin must not be started simultaneously due to high risk of severe brain hemorrhage DWI hyperintensity may persist for 2 months after stroke Cytotoxic edema accounts for DWI not vasogenic edema DWI can differentiate cytotoxic vs. vasogenic edema

Question 101

Answer 101

lipoma